AFG Area 9 ANNUAL AMIAS CERTIFICATION

AFG Area 9 ANNUAL AMIAS CERTIFICATION

To be an AFG Area 9, Florida North, Al-Anon Member Involved in Alateen Service (AMIAS)
return this fully completed form to our Area Alateen Process Person (AAPP) or AAPP CMA address
The AAPP will 1. Contact you regarding a Background Check, 2. Register this with WSO, then 3. Notify you of your WSO# and status
I have read our current Alateen Safety and Behavioral Requirements as posted on our Area website
I am at least 23 years of age (WSO requires 21, Area 9 requires 23)
I have been an active member of Al-Anon for at least the last 3 years (WSO requires 2, Area 9 requires 3)
I regularly attend at least one Al-Anon meeting each week in addition to any Alateen meeting
I do not have emotional problems which could result in harm to Alateen members
I have never been convicted of a felony
I have never been charged with child abuse or inappropriate sexual behavior
I do not have any of the Disqualifying Criminal Offenses as posted on our Area website
I agree to get a Background Check per the Area 9 Requirements as posted on our Area website
I attendedan annual AMIAS Orientation presented by an Area 9 recognized trainer
I will notify my District and the AAPP of any change in my qualifications and/or contact information
I understand that my name and contact information may be shared with those interested in Alateen
IF I am an Alateen Group Sponsor, I will send a GR-3 Group Records Change Form to the AAPP as needed
I certify that the above statements are true and I agree to abide by Area 9’s Safety and Behavioral Requirements
Al-AnonSignature: / Date:
PRINT First and Last Name:
Home Address: City, ST, Zip:
Email:
District: / Preferred Phone: / ☐Home ☐Cell
Pick ONE: / ☐Brand NewArea 9 AMIAS ☐Renew Current ☐Renew Expired / WSO#If known

Optional group level verification: To the best of my knowledge, the above Al-Anon member meets these Requirements

Group Member Signature: / Date:
PRINT Name & Group Name:

To the best of my knowledge, the above Al-Anon member meets these Requirements

Authorized District Signature:
Per Requirements- the DR or “an appointed district trusted servant” / Date:
PRINT Name & District Position